|Publication number||US8075570 B2|
|Application number||US 10/307,226|
|Publication date||Dec 13, 2011|
|Filing date||Nov 29, 2002|
|Priority date||Nov 28, 2001|
|Also published as||US20040093057, US20060069422|
|Publication number||10307226, 307226, US 8075570 B2, US 8075570B2, US-B2-8075570, US8075570 B2, US8075570B2|
|Inventors||Lee Bolduc, Alan L. Kaganov|
|Original Assignee||Aptus Endosystems, Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (88), Non-Patent Citations (6), Referenced by (23), Classifications (21), Legal Events (7)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application is continuation-in-part of U.S. patent application Ser. No. 10/271,334, filed Oct. 15, 2002, now U.S. Pat. No. 6,960,217, which claims the benefit of U.S. Provisional Application Ser. No. 60/333,937 filed Nov. 28, 2001. The full disclosures of each of these applications are incorporated herein by reference.
The invention relates generally to the attachment of a vascular prosthesis to a native vessel, and in particular, to a method and system of devices for the repair of diseased and/or damaged sections of a vessel.
The weakening of a vessel wall from damage or disease can lead to vessel dilatation and the formation of an aneurysm. Left untreated, an aneurysm can grow in size and may eventually rupture.
For example, aneurysms of the aorta primarily occur in abdominal region, usually in the infrarenal area between the renal arteries and the aortic bifurcation. Aneurysms can also occur in the thoracic region between the aortic arch and renal arteries. The rupture of an aortic aneurysm results in massive hemorrhaging and has a high rate of mortality.
Open surgical replacement of a diseased or damaged section of vessel can eliminate the risk of vessel rupture. In this procedure, the diseased or damaged section of vessel is removed and a prosthetic graft, made either in a straight of bifurcated configuration, is installed and then permanently attached and sealed to the ends of the native vessel by suture. The prosthetic grafts for these procedures are usually unsupported woven tubes and are typically made from polyester, ePTFE or other suitable materials. The grafts are longitudinally unsupported so they can accommodate changes in the morphology of the aneurysm and native vessel. However, these procedures require a large surgical incision and have a high rate of morbidity and mortality. In addition, many patients are unsuitable for this type of major surgery due to other co-morbidities.
Endovascular aneurysm repair has been introduced to overcome the problems associated with open surgical repair. The aneurysm is bridged with a vascular prosthesis, which is placed intraluminally. Typically these prosthetic grafts for aortic aneurysms are delivered collapsed on a catheter through the femoral artery. These grafts are usually designed with a fabric material attached to a metallic scaffolding (stent) structure, which expands or is expanded to contact the internal diameter of the vessel. Unlike open surgical aneurysm repair, intraluminally deployed grafts are not sutured to the native vessel, but rely on either barbs extending from the stent, which penetrate into the native vessel during deployment, or the radial expansion force of the stent itself is utilized to hold the graft in position. These graft attachment means do not provide the same level of attachment when compared to suture and can damage the native vessel upon deployment.
The invention provides systems and methods for implanting prostheses in the body. The systems and methods provide permanent attachment of the prosthesis in the body. The prosthesis can comprise, e.g., an endovascular graft, which can be deployed without damaging the native blood vessel in either an arterial or a venous system. The endovascular graft can comprise, e.g., a radially expanding vascular stent and/or a stent-graft. The graft can be placed in the vasculature, e.g., to exclude or bridge an aneurysm, for example, an abdominal aortic aneurysm. The graft desirably adapts to changes in aneurysm morphology and repairs the endovascular aneurysm. The fastening system and methods are deployed through the vasculature and manipulated from outside the body, to deliver a fastener to attach the graft to the vessel wall.
One aspect of the invention provides a fastener applier for a prosthesis. The applier comprises a drive mechanism sized and configured to be releasably coupled to the fastener to deploy the fastener into the prosthesis. The applier also includes an actuator for the drive mechanism including a sensing mechanism that enables operation of the drive mechanism in response to at least one of (i) a force sensed at or near the fastener, and (ii) contact sensed with a surface at or near the distal end of the fastener body.
Another aspect of the invention provides a fastener sized and configured for deployment in tissue. The fastener includes a fastener body having a distal end for penetrating tissue in response to a force. The fastener body also has a proximal end for releasably coupling the fastener body to a force applier. The fastener includes a stop structure associated with the proximal end to prevent over-penetration of the fastener body into tissue. In one embodiment, the stop structure couples the fastener body to the force applier, e.g., by a magnetic or mechanical coupling. On one embodiment, the fastener body can comprise, e.g., a helical coil.
Another aspect of the invention provides a fastener sized and configured for deployment in tissue. The fastener comprises a fastener body having a distal end for penetrating tissue in response to a force. The fastener body also has a proximal end for releasably coupling the fastener body to a force applier. A tracking wire is coupled to the proximal end to guide the force applier into operative contact with the fastener.
Another aspect of the invention provides a prosthesis comprising a prosthesis body and a fastener assembly integrally carried by the prosthesis body. The fastener assembly includes at least one fastener deployable into tissue in response to force applied by a force applier. A tracking wire is coupled to the fastener to guide the force applier into operative contact with the fastener.
Another aspect of the invention provides a prosthesis comprising a prosthesis body and a fastener assembly integrally carried by the prosthesis body. The assembly includes at least one fastener deployable into tissue in response to non-rotational force applied by a force applier.
The invention will be understood from the following detailed description of preferred embodiments, taken in conjunction with the accompanying drawings, wherein:
I. Delivering a Prosthesis
For the purposes of illustration,
The process of graft deployment is continued, until the graft 14 is fully deployed within the vessel. The graft 14 can be sized and configured to be either straight or bifurcated form.
A. The Prosthesis
The graft 14 desirably incorporates a support frame or scaffold 16. The scaffold 16 may be elastic, e.g., comprised of a shape memory alloy elastic stainless steel, or the like. For elastic scaffolds, expanding typically comprises releasing the scaffolding from a constraint to permit the scaffold to self-expand at the implantation site. In the illustrated arrangement, the cover 13 serves as a radial constraint. Alternatively, placement of a tubular catheter, delivery sheath, or the like over the scaffold 16 can serve to maintain the scaffold in a radially reduced configuration. In this arrangement, self-expansion of the scaffold 16 is achieved by pulling back on the radial constraining member, to permit the scaffold 16 to assume its larger diameter configuration.
Alternatively, the scaffold 16 may be constrained in an axially elongated configuration, e.g., by attaching either end of the scaffold to an internal tube, rod, catheter or the like. This maintains the scaffold 16 in the elongated, reduced diameter configuration. The scaffold 16 may then be released from such axial constraint in order to permit self-expansion.
Alternatively, the scaffold 16 may be formed from a malleable material, such as malleable stainless steel of other metals. Expansion may then comprise applying a radially expansive force within the scaffold to cause expansion, e.g., inflating a scaffold delivery catheter within the scaffold in order to affect the expansion. In this arrangement, the positioning and deployment of the endograft can be accomplished by the use of an expansion means either separate or incorporated into the deployment catheter. This will allow the endograft to be positioned within the vessel and partially deployed while checking relative position within the vessel. The expansion can be accomplished either via a balloon or mechanical expansion device. Additionally, this expansion stabilizes the position of the endograft within the artery by resisting the force of blood on the endograft until the endograft can be fully deployed.
The graft 14 may have a wide variety of conventional configurations. It can typically comprise a fabric or some other blood semi-impermeable flexible barrier which is supported by the scaffold 16, which can take the form of a stent structure. The stent structure can have any conventional stent configuration, such as zigzag, serpentine, expanding diamond, or combinations thereof. The stent structure may extend the entire length of the graft, and in some instances can be longer than the fabric components of the graft. Alternatively, the stent structure can cover only a small portion of the prosthesis, e.g., being present at the ends. The stent structure may have three or more ends when it is configured to treat bifurcated vascular regions, such as the treatment of abdominal aortic aneurysms, when the stent graft extends into the iliac arteries. In certain instances, the stent structures can be spaced apart along the entire length, or at least a major portion of the entire length, of the stent-graft, where individual stent structures are not connected to each other directly, but rather connected to the fabric or other flexible component of the graft.
One illustrative embodiment of the graft scaffold 16 or stent structure is illustrated in the area broke away in
In all of the just-described embodiments, the guidewire 610, 710, 810 can be subsequently used to deploy a fastener attachment assembly for the prosthesis 14, as will be described in greater detail next.
II. Fastening the Prosthesis
In a desired embodiment, a fastener attachment assembly is provided that makes possible intraluminal fastener attachment. The attachment assembly can be variously constructed.
A. Two Component Fastener Guide and Attachment Assembly
In one arrangement, the fastener attachment assembly comprises a fastener guide or directing component 18 and a fastener applier component 27. The guide component 18 desirably has a steerable or deflectable distal tip, which is initially deployed over the guidewire 12. In use, the guidewire 12 that is used to deliver and position the prosthesis 14 desirably remains within the vessel for subsequent deployment of the fastener guide component 18.
Optionally, the guide component 18 includes a stabilizer for holding, following removal of the guidewire 12, the deflected tip against a location in the prosthesis 14, to which a fastener 28 for the prosthesis 14 is to be applied.
In this arrangement, the applier component 27 is desirably deployed through the guide component 18. The fastener applier 27 carries at least one fastener 28 and a fastener drive mechanism 100 for advancing the fastener 28, so that it penetrates the prosthesis 14 and underlying vessel wall, to thereby anchor the prosthesis 14 firmly in place.
1. Fastener Directing Component
The directing device 18 desirably includes an integrated stabilizing device 20, which aids in maintaining position of the directing device 18 within the vessel upon removal of the guidewire 12. In one embodiment, the stabilizing device 20 is spring-loaded and is positioned for deployment when the obturator 19 and guidewire 12 are removed (see
In the illustrated embodiment (see
In another alternative embodiment (see
In another embodiment, a separate stabilization device could be used in cooperation with the directing device 18 and to access the vessel. This separate stabilization device could incorporate the forms of the stabilizing devices described above, or some other form of stabilization mechanism.
2. Fastener Applier Component
Located at the distal end of the fastener applier 27 (see
The carrier 102 is sized and configured to engage a selected fastener 28. In
The carrier 102 in
The actuation of the drive mechanism 100 can, of course, be accomplished in various ways, e.g., mechanical (i.e., manual or hand-powered), electrical, hydraulic, or pneumatic. In the illustrated embodiment (see
In use, the applier 27 is advanced through the directing device 18 and into contact with the prosthesis. The operator actuates the control unit 31 by contacting a control switch 110 (see
With the deployment of a fastener 28, the applier 27 is retrieved through the directing device 18, and another fastener 28 is loaded into the carrier 102. The directing device 18 is repositioned and stabilized, and the applier 27 is advanced again through the directing device 18 and into contact with the prosthesis 14. The operator again actuates the control unit 31 by contacting the control switch 110 to deploy another fastener 28. This process is repeated at both proximal and/or distal ends of the prosthesis 14 until the prosthesis 14 is suitably attached and sealed to the vessel wall 34. It is contemplated that from about two to about twelve fasteners 28 may be applied at each end of the prosthesis 14 to affect anchorage. The fasteners 28 can be applied in a single circumferentially space-apart row, or may be applied in more than one row with individual fasteners being axially aligned or circumferentially staggered.
An alternative embodiment of the drive mechanism 100 is shown in
The carrier 150 includes a slot 182. The slot 182 engages a drive flange 184 on the driver 29 (see
The coupling engagement between the carrier 150 and the driver 29 could be accomplished in various ways, e.g., by separate graspers or grippers, a magnetic couple, or any other suitable mechanical connecting means. In the illustrated embodiment, the driver 29 is made of a magnetized material, and the carrier 150 is made from a material that is magnetically attracted toward the magnetized material. Of course, a reverse arrangement of magnetized and magnetically attracted materials could be used.
In this arrangement, the motor coupling 132 between the drive cable 30 and the motor 106 accommodates axial displacement of the motor cable 30 (left and right in
As before described, with the deployment of a fastener 28, the applier 27 is retrieved through the directing device 18, and another fastener 28 is magnetically coupled to the driver 29. The directing device 18 is repositioned and stabilized, and the applier 27 is advanced again through the directing device 18 and into contact with the prosthesis 14. The operator again actuates the control unit 31 by contacting a control switch 110 to deploy another fastener 28. This process is repeated at both proximal and/or distal ends of the prosthesis 14 until the prosthesis 14 is suitably attached and sealed to the vessel wall 34.
As indicated in the above description, the outer diameter of the applier component 27 is desirably sized and configured to pass through the lumen of the directing component 18, which can take the form of a suitable steerable guide catheter, to direct the applier component 27 to the desired location. As also above described, the applier component 27 is desirably configured to implant one fastener 28 at a time (a so-called “single fire” approach). This is believed desirable, because it reduces the complexity of the design and accommodates access of the applier 27 through tortuous anatomy. Fastener appliers 27 which carry a single fastener can have a lower profile and may be more effective and less traumatic than fastener appliers which carry multiple fasteners. Still, in alternative embodiments, the applier component 27 may, if desired, be configured to carry multiple fasteners. Moreover, the fastener applier 27 may simultaneously deploy multiple fasteners in the preferred circumferentially spaced-apart space pattern described above.
a. Prosthesis/Tissue Contact Sensing
The fastener applier 27 desirably incorporates a function that prevents actuation of the motor 106 until the tip of the applier 27 is in a desired degree of contact with the prosthesis or tissue surface. This prevents inadvertent discharge of a fastener 28 and/or separation of the fastener 28. This function can be implemented, e.g., using a contact or force sensor, which is either mechanical or electrical in design.
When the fastener applier 27 is of the type shown in
In the illustrated embodiment, the switch 122 includes a stationary switch element 128 (coupled to the interior of the handle 108) and a movable switch element 130 (carried by the drive cable 31). In this arrangement, the motor coupling 132 between the drive cable 30 and the motor 106 accommodates axial displacement of the motor cable 30 (left and right in
Due to this arrangement, axial displacement of the drive cable 30 moves the switch element 130 relative to the switch element 128. More particularly, displacement of the drive cable 30 to the left in
A spring 126 normally biases the switch elements 128 and 130 apart, comprising an electrically opened condition. In this condition, operation of the actuating switch 110 does not serve to actuate the control unit 31, as the electrically open switch 122 interrupts conveyance of the actuation signal to the motor control unit 31. When the switch elements 128 and 130 are in the electrically opened condition, the drive cable 30 is displaced to the left to position the carrier tip 120 beyond the distal tip 124 of the fastener applier 27. The carrier tip 120 therefore makes contact with the prosthesis 14 or tissue in advance of the applier tip 124.
When the carrier tip 120 contacts the surface of the prosthesis or tissue with sufficient force to compress the spring 126, the drive cable 30 is displaced against the biasing force of the spring to the right in
Upon removal of contact force, or in the absence of sufficient contact force, the spring 126 urges the switch elements 128 and 130 toward the electrically opened condition. The distal tip of the carrier 102 is located distally beyond the distal tip of the applier 27.
It should be appreciated that the translation of movement of the carrier tip 120 to the switch 122 need not occur along the entire length of the drive cable 30. For example, the switch 122 can be located in a translation space between the carrier 102 and the driver 29. In this arrangement, the driver 29, coupled to the drive cable 30 need not accommodate axial displacement. Instead, relative movement of the carrier 102 toward the driver 29 in response to contact with the prosthesis 14 will mechanically couple the carrier 10 with the driver 29 (e.g., through a slot and flange connection similar to that shown in
When the fastener applier 27 is of the type shown in
As in the preceding embodiment, the spring 126 normally biases the switch elements 128 and 130 apart, comprising an electrically opened condition. When the switch elements 128 and 130 are in the electrically opened condition, the force sensing rod 190 is displaced to the left beyond the distal tip 124 of the fastener applier 27. The force sensing rod 190 therefore makes contact with the prosthesis 14 or scaffold structure 16 in advance of the applier tip 124.
When the rod 190 contacts the surface of the prosthesis or scaffold structure with sufficient force to compress the spring 126, the rod 190 is displaced against the biasing force of the spring 126 to the right in
Upon removal of contact force, or in the absence of sufficient contact force, the spring 126 urges the switch elements 128 and 130 toward the electrically opened condition, moving the tip of the rod 190 out beyond the distal tip 124 of the applier 27.
The contact or force sensing arrangements just described can also generate an audible and/or visual output to the operator, to indicate that sufficient contact force between the applier device 27 and the prosthesis or tissue exists.
B. Angled Component Fastener Guide and Attachment Assembly
In another arrangement (see
The drive mechanism 162 can vary. In the illustrated embodiment (shown in
III. The Fasteners
As illustrated and described thus far, introduction of the fasteners 28 will typically be affected after the prosthesis 14 has been initially placed. That is, initial placement of the prosthesis 14 will be achieved by self-expansion or balloon expansion, after which the prosthesis 14 is secured or anchored in place by the introduction of a plurality of individual fasteners. The fasteners 28 may be placed only through the fabric of the prosthesis 14, i.e., avoiding the scaffold structure. Alternately, the fasteners 28 can be introduced into and through portions of the scaffold structure itself. The prosthesis 14 may include preformed receptacles, apertures, or grommets, which are specially configured to receive the fasteners. The fasteners 28 may be introduced both through the fabric and through the scaffold structure. The fasteners can be introduced singly, i.e., one at a time, in a circumferentially spaced-apart pattern over an interior wall of the prosthesis 14.
In the exemplary embodiment, the fasteners 28 are helical fasteners, so that they can be rotated and “screwed into” the prosthesis 14 and vessel wall. A desired configuration for the helical fastener 28 (see
The proximal end 144 of the fastener serves two design functions. The first function is to engage the carrier 102 of the fastener applier 27, which rotates the helical fastener during the implantation process. The second function is to act as a stop to prevent the helical fastener from penetrating too far into the tissue.
In one embodiment (see
Alternatively (as shown in
The fasteners 28 shown in
IV. Prosthesis with Integrated Fastener Assembly
The prosthesis 500 desirably includes a fabric material or the like carried by a support frame or scaffold 504, as previously described. The scaffold 504 can be made, e.g., from an elastic material that self-expands radially during deployment from a sheath, or from a malleable material that expands radially in response to a radially expansive force applied within the scaffold by a balloon or a mechanical expansion device.
Following deployment of the prosthesis 500 in the targeted region, the integrated fastener assembly 502 on the prosthesis 500 is manipulated to anchor the prosthesis 500 to the vessel wall. In the illustrated embodiment, the prosthesis 500 carries two integrated fastener assemblies 502, one in each end region of the prosthesis 500.
In the illustrated embodiment, each fastener assembly 502 is imbedded in a reinforced flange area 506 in the respective end region. Each fastener assembly 502 comprises an array of fasteners 508 circumferentially spaced about the flange 506. The number of fasteners 508 in the array can vary, e.g., from about two to about twelve fasteners on each flange area 506. The configuration of the array can also vary, e.g., in the circumferential array, the fasteners 508 can by axially spaced apart as well.
The fasteners 508 can be formed of a metal or plastic material and can be variously constructed. In the illustrated embodiment, each fastener 508 includes a disc-shaped head 512 and a stem 514 that is bifurcated into two wings 516 and 518, which are joined by a plastic or memory material hinge region 520. The material of the hinge region 520 is formed with a resilient memory that biases the wings 516 and 518 to a spread-apart condition (as
Each fastener 508 is carried within a grommet 510 on the flange area 506 (see
In this arrangement, an intraluminal tool 522 (see
In use, the punch member 526 is manipulated to apply a pushing or punching force upon the selected fastener head 512. As
In one embodiment (see
In an alternative embodiment, an integrated fastener assembly 502 on the prosthesis 500 can be used to temporarily tack the prosthesis 500 in place while a permanent anchoring technique is carried out. For example, in this arrangement, after using the integrated fastener assembly 502 to temporarily hold the prosthesis 500 in a desired location, the separate helical fasteners 28 are deployed in the manner previously described, to permanently anchor the prosthesis 500 against the vessel wall.
It will be appreciated that the components and/or features of the preferred embodiments described herein may be used together or separately, while the depicted methods and devices may be combined or modified in whole or in part. It is contemplated that the components of the directing device, fastener applier and helical fastener may be alternately oriented relative to each other, for example, offset, bi-axial, etc. Further, it will be understood that the various embodiments may be used in additional procedures not described herein, such as vascular trauma, arterial dissections, artificial heart valve attachment and attachment of other prosthetic device within the vascular system and generally within the body.
The preferred embodiments of the invention are described above in detail for the purpose of setting forth a complete disclosure and for the sake of explanation and clarity. Those skilled in the art will envision other modifications within the scope and sprit of the present disclosure.
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|US9402623||Jul 1, 2014||Aug 2, 2016||Covidien Lp||Surgical fasteners|
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|US9526498||Jun 20, 2014||Dec 27, 2016||Covidien Lp||Surgical device with a trigger lockout mechanism device|
|US9655621||Mar 15, 2013||May 23, 2017||Covidien Lp||Surgical instrument for dispensing tacks and solution|
|US9662106||Nov 16, 2015||May 30, 2017||Covidien Lp||Surgical fastener with predetermined resorption rate|
|US9668730||May 20, 2014||Jun 6, 2017||Covidien Lp||Articulating apparatus for endoscopic procedures with timing system|
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|US20110134323 *||Feb 2, 2011||Jun 9, 2011||Tvworks, Llc||Extending Data Records for Dynamic Data and Selective Acceptance Based on Hardware Profile|
|U.S. Classification||606/142, 606/139, 623/1.23, 227/175.1|
|International Classification||A61B17/068, A61B17/064, A61B17/10, A61F2/06|
|Cooperative Classification||A61B2017/0647, A61F2002/065, A61F2002/075, A61F2/07, A61B17/068, A61F2/064, A61B17/064, A61F2/95, A61B2017/0649, A61F2/89|
|European Classification||A61B17/068, A61B17/064, A61F2/07|
|Jul 21, 2003||AS||Assignment|
Owner name: APTUS ENDOSYSTEMS, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:BOLDUC, LEE;KAGANOV, ALAN;REEL/FRAME:014305/0947
Effective date: 20030630
|Aug 23, 2005||AS||Assignment|
Owner name: PRESIDIO MANAGEMENT GROUP, INC., CALIFORNIA
Free format text: SECURITY AGREEMENT;ASSIGNOR:APTUS ENDOSYSTEMS, INC.;REEL/FRAME:016438/0113
Effective date: 20050727
|Feb 2, 2010||AS||Assignment|
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Free format text: SECURITY AGREEMENT;ASSIGNOR:APTUS ENDOSYSTEMS, INC.;REEL/FRAME:023882/0119
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|May 31, 2012||AS||Assignment|
Owner name: APTUS ENDOSYSTEMS, INC., CALIFORNIA
Free format text: RELEASE BY SECURED PARTY;ASSIGNOR:PRESIDIO MANAGEMENT GROUP, INC.;REEL/FRAME:028296/0222
Effective date: 20120529
|Sep 4, 2012||AS||Assignment|
Owner name: APTUS ENDOSYSTEMS, INC., CALIFORNIA
Free format text: RELEASE BY SECURED PARTY;ASSIGNOR:COMERICA BANK;REEL/FRAME:028893/0426
Effective date: 20120831
|Jun 15, 2015||FPAY||Fee payment|
Year of fee payment: 4
|Jul 17, 2015||AS||Assignment|
Owner name: MEDTRONIC VASCULAR, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:APTUS ENDOSYSTEMS, INC.;REEL/FRAME:036127/0486
Effective date: 20150619